摘要
目的探讨慢性肾脏病（chronickidneydiseases，CKD）4期、维持性血液透析（maintenancehemodialysis，MHD）和持续非卧床腹膜透析（continuousambulatoryperitonealdialysis，CAPD）患者睡眠质量的动态变化及其影响因素。方法选择我科住院并接受随访的128例患者，其中CKD4期（CKD4期组）患者43例、MHD患者（MHD组）41例、CAPD患者（CAPD组）44例，随访1年，每6个月用匹兹堡睡眠指数量表评估睡眠质量，并记录实验室指标。单因素及多因素Logistic分析睡眠质量的影响因素。结果3组患者间年龄、性别、社会经济因素、吸烟、体质量指数、Charlson合并症指数、原发肾脏病无统计学差异（P〉O．05）。基线和第6个月时，MHD组和CAPD组的睡眠质量总分均显著高于CKD4期组（P〈0．05）。随访第12个月时，3组间睡眠质量总分无统计学差异（P〉0．05）。同基线值相比，随访第6个月时3组睡眠质量总分均显著升高（P〈0．05）。同随访第6个月时相比，随访第12个月时CKD4期组睡眠质量总分显著升高（P〈0．05），透析组无显著改变（P〉0．05）。随着患者PSQI总分的动态变化，3组患者血红蛋白、钙磷乘积、全段甲状旁腺素和超敏C反应蛋白也发生改变。年龄（0R=1．83，P=0．01）、血红蛋白（0R=1．46，P=0．01）、钙磷乘积（0R=1．25，P=0．02）、全段甲状旁腺素（0R=1．17，P=0．03）、超敏C反应蛋白（OR=1．32，P=0．04）与睡眠质量差显著相关。结论CKD4期以上患者睡眠质量随着时间的推移逐渐恶化，老年、贫血、钙磷代谢紊乱及微炎症反应是影响睡眠质量差的独立危险因素。
Objective A longitudinal research was conducted in our center to observe the dy- namic change of sleep quality of patients with stage 4 chronic kidney disease （CKD）, subject to hemo- dialysis and continuous ambulatory peritoneal dialysis （CAPD） and to investigate the associated fac- tors. Methods Patients with CKD stage 4 （n = 43）, hemodialysis （n = 41） and CAPD （n = 44） were included and followed up for 1 year. Pittsburgh Sleep Quality Index （PSQI） and laboratory parameters were evaluated every 6 months. The univariate and multivariate Logistic regression analysis was used to analyze the associated factors. Results There was no significant difference in age, sex, socio-eco- nomic factors, smoking, BMI, Charlson comorbidity index and primary renal disease among the three groups （P〉0. 05）. At the baseline and sixth month, the PSQI scores in hemodialysis and CAPD groups were significantly higher than those in CKD stage 4 group （P〈0. 05）. At the twelfth month, there was no significant difference in PSQI scores among the three groups （P〈0. 05）. As compared with the baseline values, the PSQI scores among the three groups at the sixth month were all signifi- cantly increased （P〈0. 05）. As compared with the values at sixth month, the PSQI scores in CKD stage 4 group at the twelfth month were significantly increased （P〈0. 05）, and those in hemodialysis and CAPD groups had no significant change. With the dynamic changes of the total PSQI score, he-moglohin, calcium and phosphorus product, intact parathyroid hormone and high-sensitivity C-reactive protein also changed in the three groups. Age （OR= 1.83, P= 0. 01）, hemoglobin （OR= 1.46, P= 0.01）, calcium and phosphorus product （OR= 1.25, P = 0. 02）, intact parathyroid hormone （OR= 1.17, P=0. 03）, and high sensitivity C-reactive protein （OR= 1.32, P= 0. 04） were significantly re- lated to poor sleep. Conclusions The sleep quality of patients with CKD stage 4, subject to hemodial- ysis and CAPD progress
出处
《临床肾脏病杂志》
2015年第6期359-363,共5页
Journal Of Clinical Nephrology
关键词
慢性肾脏病
血液透析
腹膜透析
睡眠
Chronic kidney disease
Hemodialysis
Peritoneal dialysis
Sleep
